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Guidelines for Medication Administration in Schools

Guideline #1: Legal Considerations

The Minnesota Guidelines relate to the system that needs to be established
to manage safe medication administration and to the day-to-day logistics
of receiving a medication administration request from parents, have staff
trained and ready to provide the medication, document and store the medicine,
and communicate with the family and health care provider. Both the system
and the individual levels are interwoven in the 10 sections of the Minnesota
Guidelines for Medication Administration in Schools, 2005.

1.1 Relevant Laws
The legal basis for the Minnesota Guidelines for Medication Administration
in Schools is a set of federal and state laws. Short descriptions of them
and web sites are available in the appendices.

Medication administration in schools is a complex issue in part because
it intersects health laws and education laws. The laws give guidance and
set a foundation for the process that local school districts use to develop,
staff, and maintain a safe system for medication administration.

Federal Laws
Federal laws emphasize (1) the rights of students with special needs,
medical or otherwise, to have access to and to be educated in public schools,
and (2) the sensitive topic of records, including family access to education
and health records in schools.

State Laws
State laws pertain to school systems, health care practice, records, and
individual rights. In particular, they focus on access to education and
data; the provision of school health services; the establishment of local
school district medication policies; the rights of students; regulation
of health care providers, such as nurses, physicians, and pharmacists;
access to care by students; emergency care; and protection of children.

1.2 School District Policies
Within the framework of existing federal and state laws and these Minnesota
Guidelines for Medication Administration in Schools, school districts’
medication administration policies are to reflect recommended practice
and be developed in collaboration with the licensed school nurse/registered
nurse (LSN/RN), physician, and others, as listed in Minnesota Guideline
7.2.

Local policies and procedures can be individualized based on the evaluation
of the student population (e.g., individualized student health needs,
speakers of English as a second language, free and reduced lunch numbers,
and student mobility) and based on school district personnel and resources.

The various pertinent laws and the Minnesota Guidelines offer a foundation
upon which to develop and maintain individual local district policies.

The role of the school board is outlined in Minnesota Statutes §
121A.22, subd. 4:

Drugs and medicine subject to this section must be administered in
a manner consistent with instructions on the label. Drugs and medicine
subject to this section must be administered, to the extent possible,
according to school board procedures that must be developed in consultation:

(1) with a school nurse, in a district that employs a school nurse;

(2) with a licensed school nurse, in a district that employs a licensed
school nurse;

(3) with a public or private health or health-related organization,
in a district that contracts with a public or private health or health-related
organization, according to section 121A.21; or

(4) with the appropriate party, in a district that has an arrangement
approved by the commissioner of education, according to section 121A.21.

The authors of this document would like to acknowledge that the ideal
system for health and safety in Minnesota schools is to have an LSN to
manage the health services program that includes aiding school administration
in developing the system for medication administration and directing specific
procedures. An LSN with a bachelor’s degree in nursing and a certificate
in public health is an expert in nursing assessments and plans based on
knowledge of the student, school, home, and community (see National Association
of School Nurses, 2002). Using the nursing process, school nurses develop
individual health plans for students. Delegation of nursing tasks can
be a safe and effective way to perform some of the nursing interventions
identified in the individual health plan (see National Association of
Schools Nurses, 2004).

In school districts without LSNs/RNs on staff, educational administrators
working with school boards are responsible to set up a system through
which medication administration policies are developed, acceptable LSN/RN/physician
coverage for medication administration oversight via contract or other
arrangements is found, people are assigned and trained, the procedures
are done safely and consistently, and all necessary documentation is completed.
Educational administrators are also responsible to find appropriate resources
and medical expertise to address their students’ medication administration
needs. School administrators cannot legally fulfill the role of LSNs/RNs.

Those districts with LSNs/RNs on staff or on contract will be able to
call on staff to take the lead on these responsibilities.

1.3 Data Privacy
State and federal requirements ensure privacy of student education, health,
and medication records, and restrict the sharing of that information.
These laws specify how information about medication is handled, including
procedures for health records and the documentation of health information,
administration of medication, and medication errors. The state laws influencing
data privacy are the Minnesota Government Data Practices Act, the Minnesota
Medical Practice Act, the Minnesota Medical Records Act, and the Minnesota
Mental Health Act, and on the federal level, Drug and Alcohol Treatment
Records, FERPA, HIPAA, and IDEA.

Once a parent/legal guardian disclose health information to the school,
it becomes private educational data; it is the district’s responsibility
to protect the data, make sure that school employees who need the information
have it, and guarantee that staff are trained in and follow appropriate
data privacy practices.

School personnel should be cautious about easily overheard verbal communications.
There need to be firewalls for personal student health information stored
on computers.

Educators should have access to health information on a “need to
know” basis for “legitimate educational interests” as
defined in FERPA (see 34 C.F.R. § 99.31 and Health in Schools, 2003).
Schools should rely on the privacy requirements of FERPA to meet the need
to protect student privacy and the need to provide school staff with relevant
information about students (e.g., when students have medical conditions
that affect their learning and safety, such as students who have hearing
or vision problems, are subject to seizures, or have asthma or allergies).
For school staff to remain current on this topic and use student data
appropriately, training must be provided, per FERPA, HIPAA, and IDEA.

1.4 Licensed Medication Prescribers
All states, including Minnesota, have professional practice laws that
govern who is authorized to prescribe medications.

Physician’s assistant who has direction from a physician or
written protocol

Dentist

Podiatrist

Osteopath

Psychiatrist

Who is not a licensed authorized prescribing practitioner in Minnesota?

Licensed school nurse

Registered nurse

Licensed practical nurse

Medical assistant

Nutritionist

Psychologist

Naturopathic provider

Chiropractor

In addition, laws address who can delegate medication administration.
Delegation allows flexible planning to meet individual student needs and
best utilize staff available in the schools. Delegation of medication
administration by LSNs/RNs is allowed in Minnesota schools. For schools,
this is a balance between safety standards and reasonableness, given limited
resources in schools, rights and needs of students and parents/legal guardians,
and the assumption that students constitute a healthy population. Whether
or not an LSN/RN is on school staff or contracted by the school, Minnesota
law requires that school boards be responsible for policy and procedure
development leading to safe medication management.